Monday, March 29, 2010

Health care change is inversely proportional to the length of health-care legislation

Insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the [new health-care] law: coverage for certain children with pre-existing conditions.

[UPDATE, March 31: Insurance companies almost immediately backtracked and agreed to do the right thing. I am delighted that the new law is already having good effects.]

"This is what happens when Congress passes a major bill without lawmakers being able to read and digest the whole thing," Mr Neff wrote on his Facebook wall. This is not necessarily because lawmakers are lazy. H.R. 3962, the bill introduced in the House last October, is 1990 pages long; the Senate version from December is 2409 pages long; and the amendments to those bills are 153 pages long.

Still, the length of our new health-care legislation is not the problem, it's the symptom. The problem with our new law is that it does not overhaul our seriously flawed system; it merely tweaks it around the edges. After our Democratic lawmakers gave in to unfounded fears and well-funded special interests, what we got was our old failing system with a new nose job.

Don't get me wrong. I'm delighted that Americans - at least somewhere around half of us - finally believe that health care should be readily available to all. The health-care bill is an attempt to achieve that, even if inadequately and far too slowly. I am glad the bill passed, if only because it represents the first step in a necessary journey.

And its inadequacies do not necessarily mean that all is lost. In The Healing of America, T.R. Reid quotes economist Tsung-Mei Cheng on what he calls "the Universal Laws of Health Care Systems:"

1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.
3. The last reform always failed.

If our 2400-page bill turns out to be an expensive failure, maybe then our people will be humble enough to learn from countries who have made universal health care work - and who spend half what we already do.

Here's the good news: when we are finally ready to make the fundamental changes that will truly make a difference, we won't need a 2000-page bill. It is simpler to describe a good system than to emend a bad one. Last Monday I blogged about Switzerland's health-care overhaul in the mid 90s. Today I looked up the bill that transformed their system. La loi fédérale sur l'assurance-maladie of 1994, together with all of its revisions up to this year, is 60 pages long.